| NPI | 1083058648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: CO DR.0060292) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO DR.0060292) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2021-03-17 |